LWB Pediatric Cardiac Database

The problem: Inequity in accessing pediatric cardiac care.

The global scale of the problem: Up to 90% of babies born with heart defects in developing countries do not have access to required healthcare. Their birth location often dictates their very survival.

How many people are affected in Uganda: It is estimated that 8300 children are born with congenital heart disease each year in Uganda, with at least 2000 of these children needing medical intervention. In addition, there are acquired heart conditions, such as rheumatic heart disease, which can lead to children needing heart surgery.

The scale of the problem in Uganda: The Uganda Heart Institute (UHI) is the only cardiac hospital in Uganda. UHI can treat a small number of these children but the majority cannot be helped in Uganda, either due to the complexity of their defect, the cost of the surgery, and/or the long waiting list to receive surgery at UHI. Time constraints on cardiologists at UHI mean that they cannot fully explain the diagnoses they give, leaving families confused about their child’s condition and its implications. Families may not understand that their child needs palliative or hospice care, how nutrition and exercise will affect their child’s health, or that the window to receive surgery will close.

Contributing factors: Because of the gap between diagnosis and the availability of treatment, the UHI and doctors at other organizations tell families that not only will their child need surgery, but in many cases they must arrange for and fund a trip abroad for treatment, or else the child will die. This is a truly overwhelming proposition for most Ugandan families. Many families are unable to pay for treatment and travel.

LWB and other charities have sought to bridge the gap by providing financial assistance for travel and surgery for underserved children. The UHI and other cardiologists often give families a list of these charities, but each charity has its own application process. Families are left to ‘scramble’ for options, while caring for their sick child. Many children of underserved families do not have birth certificates, so obtaining a passport to travel is even more complicated. Some families are more adept at computer applications and scanning documents, while others do not even have access to a computer, leaving them unable to search for help or fundraise. There is also a significant overlap of applications between charities. Families may pursue help with one, while also working with another, which leads to a waste of funding that could have helped more children.

Additionally, some families navigate traveling abroad to India and other countries for surgery on their own. Concerns have been raised about variable quality and costs of hospitals competing for these medical tourists.  (https://tourisms.gov.in/sites/default/files/2020-04/Med.pdf). Ugandan cardiologists have given numerous anecdotal reports of children returning to Uganda in critical condition, after families have spent over $20,000 in India for surgical care. There is currently no way to track these outcomes in a centralized place to identify any patterns of sub-optimal care. 

What is our solution?: LWB has configured a simple, online, secure database capable of capturing the information of all of the children in Uganda who need cardiac intervention.

How it works:  Because computer literacy is so variable in Uganda, families call a hotline number given to them by their child’s doctor. Then a compassionate member of LWB’s staff collects their information and enters it into our database.

Once metrics (as described below in the section describing the core technology that powers our solution) are collected, our Team Lead—a Ugandan pediatric cardiologist—reviews all entries every day and assigns each case a priority level for surgery based on the severity of the child’s condition, not the family’s ability to pay.

What does it do?: By streamlining families’ application process and organizing cases, LWB is able to quickly identify children to assist when funds become available. LWB also aims to work collaboratively with other charities, giving them access to the database so they can identify children they have the funds and capacity to help. This means that families will not have to apply to multiple charities at once and it reduces overlap in services. It will also decrease the administrative, ‘on the ground’ cost for the other charities, with the assumption that more funding will be directed to surgical care. 

Apart from lifesaving surgery, the other metrics collected enable children to receive other types of care. Location information allows cardiologists to identify diagnostic patterns in certain regions, as well as identify regions where there appears to be a lack of diagnoses. Children who have severe conditions and who are unlikely to be able to receive surgery are referred to hospice/palliative care associations in their home region. If co-morbidities are identified, such as malnutrition, appropriate referrals are made. Additionally, there are now educational opportunities allowing all families in a region to be easily identified, contacted, and brought together for support and given a chance to better understand their children’s diagnoses.

Birth certificate and passport information streamlines the delivery of care. Passports require time and intensive paperwork to obtain. Often, a child who has been selected for surgery becomes too ill to make the trip abroad. The database allows charities to quickly see which children have their paperwork in order so they can take the next available spot. This means more children will receive surgery.

There is a charity that specifically seeks to fund medical care for children with Down syndrome, who often have congenital heart disease. If LWB does not have the funding to help a child with Down syndrome, we can call this charity to offer the case to them.  

The database also allows for tracking and follow-up with families who may independently seek care overseas, enabling data collection about unscrupulous organizations in the medical tourism arena.

What technology does it use?: The solution employs two types of technology. 1) A telephone hotline number, and 2) A MySQL database accessible to LWB staff via a browser-based web application. 

Target population: Ugandan children who need cardiac intervention and their families. Many of these families typically bring a sick child to a clinic or hospital and receive a serious diagnosis. Those who cannot pay for care or whose child’s condition is more severe than the Uganda Heart Institute can treat receive a confusing set of instructions about heart charities to contact to request financial support for care for their child abroad.

How they are underserved: Many of these families are underserved because overwhelmed medical personnel do not have time to walk them through the confusing process of arranging care for their children. In addition, many families are not computer savvy and/or do not have a smartphone, computer, or any way to access the internet. Some of these families are illiterate or speak a minority language and cannot navigate the complex forms needed to request help from a charity. Others are not fully informed that their child’s condition is inoperable, and they receive no guidance in finding appropriate palliative or hospice care. 

How the solution addresses their needs: The solution will address their needs by simplifying the process of navigating the health system. Instead of looking up many forms online, families will have a single number to call. They will be able to ‘apply once’ to all the organizations who might be able to sponsor them. 

LWB staff will speak directly with families and enter their child’s information into the database for them, offering human connection and compassion at a time of great confusion and stress. Language barriers will be addressed because LWB’s Ugandan staff speak a variety of local languages including Lugandan, Runyankore, Lusoga, Japadhola, Alur, Ateso, Kiswahili, French, and English.

The solution further addresses children’s needs because a pediatric cardiologist will analyze the entries daily and will be able to understand what type of care a child needs based on the tracked metrics. LWB staff will help connect children with an appropriate charity or other appropriate care. This will streamline the process of connecting underserved children with care, and the resulting increased efficiency will increase the number of heart procedures that charities are able to fund.

LWB remains committed to supporting the work of UHI and all available resources within Uganda to serve children and families in-country. We seek to invest in those systems whenever possible and when they can provide the care that is required. The hope remains that there will be an increase in the number of surgeries that can be performed in Uganda, and there will be increased government funding set aside for them. In the meantime, the database will demonstrate that for most children needing surgery, going abroad is currently the only option.

We estimate that streamlining this process will double the number of heart surgeries LWB is able to help families obtain from 15-20 annually to 30-40. We cannot speak to the exact increase other charities will experience, but it is certain that they will also be able to identify and help more children. 

How we are well-positioned to deliver this solution: When our work in Uganda began in 2017, we quickly became aware of countless children in need of life-saving heart surgeries who were not visible to any existing database in Uganda’s healthcare system. Our strong relationships with community leaders and healthcare providers, both in-country and overseas, led to the creation of an impactful medical travel program, overseen by an experienced cardiologist and team of local nurses. This has enabled more than 80 Ugandan children to receive the surgical care that they otherwise could not access. We are well-known as a heart charity in Uganda and receive hundreds of applications for aid every year via email, phone, or walk-in requests. Because we receive word-of-mouth referrals for assistance and rely on direct patient communication, we can identify patients who exist outside the awareness of Uganda’s health system.

LWB’s Team Lead: The Team Lead and Executive Director of LWB's Uganda Cardiac Program, Dr. Proscovia Mugaba, is from Uganda and is the first female accredited Ugandan pediatric cardiologist. After completing two fellowships in Canada, she moved back to Uganda and is committed to holistically helping Ugandan children with heart issues. She works as a part-time consultant Pediatric and Fetal Cardiologist at Nsambya Hospital and other institutions and organizations in Uganda.  Her vision for equitable access to care led to the creation of our database.

Other key Team members: Ugandan Managers Ronald and Joy Ssejjuuko are parents of a child who received critical heart surgery overseas at a young age. When families whose children have cardiac conditions call LWB, the managers understand the desperation, emotion, and hopelessness involved as well as the daunting feeling of having to navigate international travel and complicated healthcare systems. The couple oversees three local nurses who have all traveled as nurse escorts to hospitals in India and Israel, helping more than eighty children from Uganda receive necessary cardiac surgery through LWB.

How the solution is guided by the community’s input, ideas, and agendas: Ugandan cardiologists are the community that has guided the solution. These doctors are frustrated by the limited resources available to help their patients. They have the ability to diagnose, but not help children with more complex cases. When LWB speaks with these doctors, they express a desire for a material way to help more of their patients. They have mentioned that they don’t have time or space to track cases themselves or connect patients with available funding or other resources. 

Dr. Mugaba had a vision of being able to capture this data for follow up with families, education, outcome tracking, and streamlining access to care. She wants this information to be at the fingertips of all the physicians in Uganda so they can refer their patients for care more easily. She also wants to identify gaps in care where patients are falling in the cracks, track the outcomes of interventions given, and truly understand the scope of the pediatric cardiac care situation in Uganda.  

What has been built so far: LWB uses Medida software, a web application that stores and tracks both operational program data and impact data. LWB has worked with Medida to create custom metrics with a form for easy data-collection. LWB’s team has been trained in capturing data and searching within the database. The database maintains a precise record for our metrics over time without the need for complex configuration, data pipelines, or data-cleaning.

LWB has established a hotline number and distributed it to care teams at the Uganda Heart Institute and other medical facilities and physicians’ offices across Uganda. Doctors and care teams have been giving this number to families whose children receive a cardiac diagnosis. LWB is registered with the Ugandan government to collect data, and families can already call the hotline number and have trained LWB staff enter their child’s information into the database.

How many beneficiaries have been served: The database has been operational since March 1, 2024. In the first two weeks of the program, ten families called the hotline, and their data was captured. As of April 15, 2024, the database holds the health information of forty-five children. Our Team Lead has assigned priority intervention numbers for the cases based on who needs surgery first before they become inoperable. Eight children have already been referred for cardiac surgery.

LWB plans to reach out to other charities by May 2024 to further assess their interest in using the database to identify children for surgery. So far, we have had an initial conversation with Hearts of Joy, a charity that funds medical care for children with Down syndrome. Their initial reaction was positive, and they stated they are likely to use the database in the future. Other charities we plan to reach out to include, but are not limited to, Morningstar, Chain of Hope, and Gift of Life.

Market barrier: The solution is new and relatively unknown.

How the barrier presents a challenge: While the database is already useful to LWB, it will more effectively serve children if more charities use it. However, it can be tough to convince other organizations to add a new step to established routines. Additionally, attention at the national level and globally can help us secure funding, partnerships, and governmental buy-in.  

How can Solve help: Solve’s nine-month support program offers marketing tools and connections with mentors experienced in facilitating organizational buy-in. This will help us present a compelling case to other charities and position our solution properly within Ugandan charitable spaces. Additionally, media exposure from selection as a Solver will attract interested skilled partners and donors.

How this will advance our solution: The more charities using this database, and the more well-known the solution becomes, the more children can be connected to care.

Legal barrier: There is no equitable government-level requirement to track and prioritize pediatric cardiac cases in Uganda based on case severity and likelihood of a positive outcome.

How the barrier presents a challenge: No matter how useful the database is, without government buy-in we cannot hope to track all the known children’s cardiac cases in Uganda.

How can Solve help: The US organ donor database accomplishes fair and just distribution of limited medical resources. We hope Uganda’s government will endorse an analogous program for pediatric cardiac cases. Our database could serve as the foundation for this national system. MIT Solvers are offered pro-bono legal advice we could use when planning national-level advocacy for such a system.

How this will advance our solution: By garnering governmental approval, LWB can expand the reach of the database, capture more cases, and create a more complete picture of the pediatric cardiac care situation in Uganda. This more complete data set would better inform national health policy and connect more children to care.

Technical barrier: Technical complexity of the project’s database and dataset.

How the barrier presents a challenge: LWB’s staff are not IT experts. Currently, we rely entirely on software company Medida’s guidance in the use and maintenance of our dataset. Medida’s services have been extremely helpful so far. As our solution grows, we anticipate several challenges. First, we intend to make the dataset sharable, and that goal carries data privacy concerns. Second, LWB has limited understanding of developing and refining metrics. Third, over time, our project may require additional capabilities.  

How Solve can help: The opinion of a trustworthy third party would be helpful in guiding our decisions regarding our software solution. Solve can connect us with experts in data management and security to provide opinions and/or audit our system to ensure we are protecting patient confidentiality. Solve can also help refine the project’s metrics.

How will this advance our solution: The right software to expand and advance the database’s capabilities and the guidance to manage it will allow for the successful conduct and future growth of the project. 

How the solution is innovative: Telephones are widely available and in use in Uganda, and our innovative hotline eliminates the technology barrier that so often frustrates the ability of families to receive the care they need. The solution proposed is innovative in that it aims to directly collect data on children with cardiac defects in Uganda, and then track their cases, refer them to additional services as needed, and connect them to available opportunities to receive surgery or other supportive care. This has not been done before.

How it could catalyze broader positive impacts from others in this space: There are several heart charities operating in Uganda (Morningstar, Hearts of Joy, Chain of Hope, Gift of Life, Action for Disadvantaged People, and others), and all of them have limited funds with which to help as many children as possible. Many times, there is overlap in the profile of children that a charity helps. For instance, LWB will provide surgery to any Ugandan children, while Hearts of Joy is a charity that provides surgery only to children with Down syndrome. If LWB has insufficient funds for an applicant child’s surgery, Hearts of Joy might be able to accept their case if they have Down syndrome. The database will end the process of parents having to apply to all the different charities who are operating in the area to find one that can take their specific case.

How it could change the market/landscape: The database will lead to a more efficient use of charity funds, allowing more children to receive care. It will also get children care faster, which increases their chance of a successful outcome. We also aim to collect outcome data on an unregulated type of cross-national medical care (medical tourism). This will expose bad actors and increase safety for desperate families seeking medical care for their children.

Additionally, we will provide cardiac education to a significant number of families whose children have diagnosed cardiac conditions. Some children require nutritional and lifestyle intervention. The database will be used to identify such cases and connect families with education and help to support their children’s health. In cases where children are terminally ill and need palliative care, we have connections with hospice organizations to which they can be referred. This is something that is not currently happening at all for families. 

The problem:  Many Ugandan families face barriers to securing funds from medical charities. These include lack of internet or computer access, language barriers, literacy barriers, and numerous complex forms.

The goal:  To improve health outcomes for Ugandan children with heart conditions, regardless of their family’s income, minority status, language, literacy level, or internet access.

How the program will achieve this goal: By maintaining a database of all pediatric heart cases in Uganda. 

Assumptions underlying the Theory of Change: 

• A streamlined process to connect with underserved pediatric heart patients, track their data, connect them with care, and monitor their outcomes will measurably improve cardiac care for this population.
• A single hotline number to replace complex forms from multiple charities will make obtaining care simpler.
• All heart charities operating in Uganda will find value in the database and use it to identify children to help.

Activities:

• The team distributes the hotline number to the Uganda Heart Institute and physicians across Uganda.
• The hotline rings to a member of LWB’s multilingual project team, who enters a family’s information into the database.
• Team Lead Dr. Mugaba examines the database nightly to assess the urgency of new cases and monitor the status of existing ones. 
• LWB staff check availability of LWB funds. As funding becomes available, the LWB team chooses children to help based on their condition’s urgency. The data is available to other charities who will also identify children to help.
• Outcome measures are collected, including children who may have fallen prey to medical tourism scams.

Outputs:

• A database of all Ugandan pediatric cardiac patients with tracked data and monitored outcomes is updated daily with new information and examined daily by a pediatric cardiologist.
• A hotline phone number is given to all pediatric cardiac patients throughout Uganda. 
• A compassionate, knowledgeable, multi-lingual team records data and guides families through the steps in accessing care.
• Other charities receive updated, comprehensive information on pediatric heart cases.
• Families are connected with appropriate care and available funding.

Real changes in people’s lives:

• A single hotline minimizes the burden on families searching for help, giving them more time for work and caring for children with complex heart conditions.
• Having an LWB staff member actually enter the child’s information into the database makes families feel heard and supported. They are assured that we have entered all needed information. They are advised on the documents they need should they be selected to travel.
• Streamlining the process means more children will receive surgery before their conditions worsen and they become inoperable.
• More charities will see a child’s case than if their family were looking for funding without guidance. 
• Families who might have been approved by multiple charities are approved by one charity, thus freeing up resources to help more children. 
• Families are informed of the reality of their child’s case and educated on care options, including nutrition, medication, palliative, or hospice care.
• Fewer families fall prey to unscrupulous medical tourism scams.
• More children receive heart surgery and have better health outcomes.

Impact Goal 1: To capture health data in order to ensure equitable access to pediatric cardiac care in Uganda. Our aim is to make all Ugandan children who need heart surgery visible to all the charities who could pay for their care. This will be achieved by increasing the number of cases in the database and organizing health information in a way that is meaningful for doctors.

Associated UN Sustainable Impact Goal: Target 3.8-Achieve access to quality, essential healthcare services.

Indicators we use to measure progress towards Goal 1: (UN indicator: Coverage of essential health services). Currently, only children with known and monitored cases receive health care. By capturing more children’s data, we will increase the number of children who receive care. We will measure this by the number of cases entered into the database.

Impact Goal 2: To use the database in a manner that leads to more children receiving heart surgery.

Associated UN Sustainable Impact Goal: Target 3.4 - By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

Indicators we use to measure progress towards Goal 2: (UN Indicator: Mortality rate attributed to cardiovascular disease). The database monitors outcomes. We know we have achieved our goal if a greater number of children with serious heart conditions receive lifesaving care.

Impact Goal 3: To reduce inequality of outcomes for pediatric heart patients in Uganda.

Associated UN Sustainable Impact Goal: Target 10.3 Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.

Indicators we use to measure progress towards Goal 3: The number of Ugandan children from families unable to pay for care who receive appropriate care (whether surgical, educational, nutritional, palliative, or hospice care) indicates progress toward this goal.

Impact Goal 4: To support families as they navigate the medical care system for their child’s condition.

Associated UN Sustainable Impact Goal: None. This is our own goal.

How we are measuring progress towards Goal 4: We measure progress toward this goal by the number of families who receive education about the nutrition and lifestyle that children with heart conditions need. Also, we measure progress by the number of families who leave their cardiologist’s office fully understanding that their child’s condition is inoperable (if that is the case). Finally, when a child cannot receive surgery, we measure progress toward our goal of supporting families by the number of families our staff walks through the difficult reality that their child needs palliative or hospice care all the way through successfully connecting them with a palliative care or hospice program that will give their child the best quality of life possible. 

Our solution relies on two core technologies:

1) Telephone hotline: Although a direct human-to-human call line is not a new technology, it is a technology that is widely available and used in Uganda. The interpersonal nature of a conversation is very much a part of Ugandan culture and tradition, versus employing an online survey or other impersonal technology that may intimidate those who are not technologically literate, or people who do not own a smartphone or have access to a computer.

2) Database: Medida is a centrally-located MySQL database where data is stored in raw form. The LWB team interacts with it via a browser-based web application that is lightweight and easy to download and use in low-internet environments. The web application interacts with the MySQL database via a Laravel/PHP backend which manipulates incoming data according to LWB’s defined data structure.

The software allows LWB staff to associate specific form questions with specific metrics, and also to associate specific form responses with specific beneficiaries in the database, so that submitted question answers are automatically saved as metric values on an associated beneficiary without any configuration necessary by the user. This ensures the data collected is automatically organized and clean, and key performance indicators can be tracked automatically using live reports generated from metric data.

LWB is using the following metrics for the database:

First name

Last name

Nickname

Date of birth

Gender

Personal ID number

Contact Information

Email

Phone number

Emergency phone number

Address

Demographic information

Place of origin

Ethnicity

First language

Second language

Third language

Extra information

Other names

Name of mother

Name of father

Mother´s occupation

Father´s occupation

Child’s primary caregiver(s)

Caregiver relation to child

Priority Intervention--Select option--Level 1, Level 2, Level 3

Prenatal Diagnosis

Folic acid

Down syndrome

Date when first diagnosed with heart disease

Was family told that they would need to go overseas for the surgery?

Where does the child live, what region?

Family history of cardiac disease

Maternal conditions in pregnancy

Other medications taken during pregnancy

Does child have other known medical conditions?

Is another syndrome suspected?

Surgical or catheter interventions

Intervention date

Email where to best reach family

Phone number to reach primary caretaker of child

Additional phone numbers

WhatsApp number

Additional information

Does the child have passport?

Does the parent have passport?

Additional notes

Notes about travel (add any circumstances that could make the travel challenging)

The solution uses technology to benefit people in Ugandan communities and also around the world: This database will immediately and directly benefit the people of Uganda. In addition to Uganda, LWB serves children in China, Guatemala, India, and Cambodia. We will examine ways the database model can be applied in those countries as well. Additionally, it is our hope that the database will serve as a model for other countries in Africa and around the world to track children’s medical conditions and streamline care in equitable ways.

Full time staff: 1

Program manager Ronald Ssejjuuko has a degree in IT from Uganda Christian University. His son received heart surgery through LWB.

Part time staff: 6

Pediatric cardiologist Dr. Proscovia Mugaba will be the Team Lead.

Registered nurse Sharon Karungi will oversee the database and collect data.

Registered nurse Charity Asiimwe will collect data.

Registered Nurse Deziranta Nakanyike will collect data.

Strategic Director for LWB’s Africa programs Christina Linsdeth will coordinate the project.

Associate Director Gail Crawford will work on budgets and administration, drawing on vast previous experience with similar work for the US Department of Defense. 

LWB has been developing the database for approximately six months, since the fall of 2023. However, the Uganda pediatric cardiac program has been in place for over four years, leading to the conceptualization of the database based on the existing unmet needs.

Diversity Equity and Inclusion within LWB: LWB board members, staff, and volunteers represent a wide range of religious, racial, and cultural backgrounds. LWB intentionally hires program managers and directors from the communities we serve, because the most effective solutions are developed and directed by the people who are most familiar with the situations on the ground. We strive to create an environment that values, respects, and leverages the variety of perspectives and lived experiences that our board members, staff, and volunteers bring to the table. LWB, which has no religious affiliation, is committed to serving all children, and welcomes, celebrates, and promotes staff and board members of every religion, race, cultural background, gender, and LGBTQ+ identity.

Our continuing goal to become more diverse, equitable and inclusive: 

As pertaining to data:

• We review compensation data across the organization (and by staff levels) to identify disparities by race.
• We ask team members to identify racial disparities in their programs.
• We analyze disaggregated data and root causes of race disparities that impact the organization's programs and the populations served.
• We disaggregate data to adjust programming goals to keep pace with changing needs of the communities we support.
• We employ non-traditional ways of gathering feedback on programs and trainings, which may include interviews, roundtables, and external reviews with/by community stakeholders.
• We have long-term strategic plans and measurable goals for creating a culture such that one’s race identity has no influence on how they fare within the organization.

As pertaining to policies and processes:

• We seek individuals from various race backgrounds for board and executive director/CEO positions within our organization.
• We have community representation at the board level, either on the board itself or through a community advisory board.
• We help senior leadership understand how to be inclusive leaders with learning approaches that emphasize reflection, iteration, and adaptability.
• We engage everyone, from the board to staff levels of the organization, in race equity work and ensure that individuals understand their roles in creating culture such that one’s race identity has no influence on how they fare within the organization. 

Diversity Equity and Inclusion within the database project team: Dr. Proscovia Mugaba, LWB’s Team Lead for the project and Executive Director of our Cardiac Program, is the first accredited female Ugandan pediatric cardiologist. Our LWB staff in Uganda speak a variety of local languages. The project was catalyzed by the in-country staff and cardiologists receiving an overwhelming number of requests for care from desperate families. 

Equity in care is at the core of the project: This project directly seeks to eliminate barriers for families whose children need cardiac surgery. The project specifically targets those families underserved due to financial constraints and literacy/computer literacy barriers. Anyone who can access a phone line can call for help and have their data recorded, and then be considered for surgery or other assistance.

LWB is an international charity that provides hope and healing to vulnerable children, and their underserved communities, through its education, nutrition, medical, and foster care programs. Our programs work together to meet the whole needs of the children we help. Our beneficiaries are the children we serve in China, Uganda, Guatemala, Cambodia, and India. We are primarily funded through private donations, and have an annual operating budget of $3.8 million. 

Services we provide: 

• Medical Care: LWB provides lifesaving surgeries to children whose families cannot afford their care. In addition, we run cleft and hernia repair camps in the countries we serve.
• Family-based Foster Care: Children thrive in families, not institutions. When children are unable to stay with their biological family, family-based foster care in the community of their birth is the best option for children’s mental health and development. LWB trains foster parents and monitors foster homes as we help families work toward reunification where possible.
• Education: Education is the best way to break the cycle of poverty. Too many children have no access to quality education. LWB runs free high-quality schools in impoverished areas in some of the countries where we operate that focus on learning through play and discovery. We teach the national curriculum in all of these schools so students will be prepared to excel on national standardized tests and be more likely to move on to employment or post-secondary education. LWB also provides college scholarships and vocational training opportunities to deserving children who are impoverished or otherwise face other barriers to education.
• Nutrition: Nutrition is the bedrock of health, education, and thriving within a family. LWB provides emergency food relief to struggling communities, and also nutrition programs in our schools, healing homes, and foster homes, ensuring that the children we serve and their families have adequate access to food.

Sustained Donations: LWB is primarily funded by charitable donations from individuals. We have a robust donor base which has helped us provide surgery to more than 1,300 children in the countries we serve since 2003. Ten thousand dollars of our existing cardiac program funds will be directed to sustain the database each year. Salaries for our full-time and part-time staff members will continue to be paid through program and general funds. Further expansion of the cardiac database could be achieved by scaling up our project to serve pediatric cardiac patients and their families in other low and low-to-moderate income countries in Africa and around the world. This expanded system could become financially sustainable by inviting various stakeholders, such as other charities, NGOs, researchers, medical providers, and hospital systems, to invest time, service, and financial resources.